Medical Research Archives 2015 Issue 3

MYOFASCIA – THE UNEXPLORED TISSUE:

MYOFASCIAL KINETIC LINES IN HORSES, A
MODEL FOR DESCRIBING LOCOMOTION USING
COMPARATIVE DISSECTION STUDIES DERIVED
FROM HUMAN LINES

Vibeke Sødring Elbrønd1*, Rikke Mark Schultz2

1
Department of Clinical Veterinary Animal Science, Faculty of Health Sciences, University of
Copenhagen; Denmark.
2
RMS Equine Practice, Karlebovej 22, DK- 2980 Kokkedal.

*Corresponding author:
Dr. Vibeke Sødring Elbrønd,
Dept. of Clinical Veterinary and Animal Science,
Div. of Veterinary Anatomy and Biochemistry,
University of Copenhagen,
Groennegaardsvej 7,
DK‐1870 Frederiksberg C
Email: vse@sund.ku.dk

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Medical Research Archives 2015 Issue 3

ABSTRACT

The precise functional role of connective tissue, and especially that of myofascia,
remains largely unexplored. With this in mind, the present study has chosen to focus on an
improved understanding of the interconnected web of fascia formed by connective tissue
throughout the whole body, with particular consideration to force transmission, biomechanics
of the whole body and fascia contractility. The specific aim of the present study was to reveal
the inter-connective functionality of the locomotory system in a mammal other than humans,
namely the horse.
Dissections of horses (n=26) were undertaken in order to verify the existence of, as
well as compare the similar functional interconnected lines and structures to, those found in
humans. This study found that it was necessary to redefine the human lines that have already
been described, owing to variations specific to horses arising from fundamental anatomical
differences between bipeds and quadrupeds. Nevertheless, the myofascial kinetic lines
presented in this study provide an anatomical foundation for an improved understanding of
locomotion. Indeed, one in which the whole body is considered in a holistic way, rather than
the simplified description of the action of single muscles. It is concluded that the lines
described in this study form the basis of a readily use-able tool that can be applied by
practitioners to track the main cause of locomotory problems in horses afflicted with impaired
performance.

Keywords: Biomechanics; Equine; Fascia; Functional lines; Locomotion; Myofascia

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Medical Research Archives
1. INTRODUCTION
Very little attention has been paid
to the connective tissue and its intimate
anatomical associations to muscles such as
the myofascia or indeed, the connections
between muscles. In terms of embryology
and the origins of connective tissue, it is
believed to be mesodermal, representing a
tissue that provides a three-dimensional
interconnected network throughout the
whole body (Paoletti, 2001; Klingler et al.,
2014). In traditional anatomy, muscles are
described as single units having an origin,
insertion, function and internal relation as
well as being either agonistic or
antagonistic (Nickel et al., 1977; König et
Liebich, 2009). A good example of the
fascia web is the way in which the
endomysium, perimysium and epimysium
envelope the muscle fibers, the fascicle
and finally the whole muscle, merging
together to form the tendons or ligaments
before they enter the periosteum and
connect into the connective tissue skeleton
of bones (Nickel et al., 1977; Huijing,
2003). According to Yucesoy and Huijing
(2007), muscles, when intact with their
connective tissue surroundings, are not
isolated and independent entities but
should rather be seen as collagenous
linkages or connections between epimysia
of adjacent muscles, thereby providing
direct intermuscular connections.
Furthermore, the intermuscular septa,
interosseal membranes, periost and
compartmental fascia serve to connect
muscular and non‐muscular tissues.
Epimuscular myofascial force transmission
occurring through these connections has
major effects on muscular mechanics –
including for example energy
conservation, recoil and shock absorption
(Yucesoy and Huijing, 2007).
The considerable importance of
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2015 Issue 3
both areolar (“loose” connective
tissue/superficial fascia) and dense
connective tissue and thereby fascia tissue,
has been revealed through recent research
in humans (Schleip et al. 2012a). It has
been shown that this tissue plays an
important role in the locomotory system
and thereby has an influence on
biomechanics and posture of humans and
animals alike (Schleip et al. 2012a).
Purslow (2009) describes how the
perimysium and epimysium can act as
pathways for myofascial force
transmission. Likewise, myofascial force
transmission between both the agonistic
and antagonistic muscles has been shown
in vitro and in vivo in humans and rats
(Carvalhais et al., 2013; Tian et al., 2012;
Huijing et al., 2011; Yucesoy et al., 2010;
Huijing et Baan, 2008). Maas and
Sandercock (2008) suggested epimuscular
myofascial force transmission via
connective tissue to the Achilles tendon in
m.soleus of tenotomysed cats. Moreover,
according to Purslow (2002) the
endomysium has an increased role in force
transmission in injured muscles.
Research in the field of
mechanobiology has shown different
qualities of contractility of areolar and
dense connective tissue (Langevin et al.,
2013). In areolar connective tissue
fibroblasts exhibit a fast (within minutes)
dynamic cytoskeleton remodelling in order
to adapt connective tissue tension
(Langevin et al., 2004; Langevin et al.,
2006; Langevin et al., 2013). Whereas
tension in myofascia occurs more slowly
when fibroblasts diversify into
myofibroblasts and provide it with strong
contractile properties often over long time
periods (hours to weeks) (Langevin et al.,
2011). Myofibroblasts are well known for
their role in open wound healing where
they contract the wound edges. It has been
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suggested that they may instigate a positive
feedback mechanism, which is to say that
the contraction forces increase with fascial
tension - providing a static tension which is
only released upon myofibroblast
apoptosis (Tomasek et al., 2002). This
contractility can provide fascial stiffness
(Schleip et al. 2006a; 2006b; Van De
Water et al., 2012; Klingler et al., 2014).
Myofibroblasts have also been shown to be
involved in fibrosis in scar tissue, and
deformation of the surrounding connective
tissue (Van De Water et al., 2013; Wipff et
al., 2007). In humans, scar tissue
formation and fibrosis leads to a loss of
function and susceptibility to recurring
injury (Best et al. 2013). According to
Stecco and colleagues (2011) skin
ligaments connecting the skin to the
areolar connective tissue are visible using
CT, MR and ultrasound and there is a
further connection into the deep fascia.
Therefore, it is important to consider how
scar tissue in skin, fascia and muscles
might influence the function of the
structures associated with the deeper and
more profound parts of the locomotory
system.
It is also important to consider the
role of myofascial tension in body balance
and posture just as one does in terms of
agonist and antagonist muscles (Nickel,
1977; König and Liebich, 2004).
According to Stecco and colleagues (2011)
there is increasing evidence that fascia
plays an important role in movement
perception and coordination. Tomasek and
coworkers (2002) state that “…tissue
tension is an essential regulator of tissue
function…” both for visceral and somatic
tissue. Furthermore, Masi and colleagues
(2010) describe the importance of human
resting myofascial tension in terms of
postural balance, something that is
supported by the biomechanical principles
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2015 Issue 3
of myofascial elasticity, tension and stress.
Understanding the fascia as an
interconnected web with fascial force
transmission, dynamic and static
contractility affecting body posture and
balance, introduces the importance of
being knowledgeable about myofascial
distribution, its connections throughout the
body, and its effects on locomotion and
posture.
In order to describe posture and
motion of the whole body, myofascial
kinetic lines consisting of rows of
interconnected anatomical structures,
which functionally direct the basic motion
patterns of the musculoskeletal system,
should be considered. These
interconnections of muscles, tendons and
fascia, have already been described in
humans by several authors, among them
Busquet, Struyf‐Denis and Myers as
presented by Schleip and colleagues
(2012) and Richter and Hebgen (2009).
Denoix and Pailloux (2009) describe the
dorsal and ventral muscular chains in
horses as “creating a functional unity” and
due to such myofascial connections, any
form of biomechanical disorder can be
expected to create problems within the
chain or at some distance. The term
“chains” has its origin in the well-
­‐recognized “Bow and String” theory
(Sleijper, 1946). Sleijper (1946) stated
that the epaxial spinal muscles work as
antagonists to the abdominal muscles in
order to maintain body balance. The “stay
apparatus” is another well-recognized
structure for maintaining posture. Several
researchers have studied separate parts of
the passive stay apparatus on respectively
the front limb and the hind limb under
different clinical and pathological
conditions. Gussekloo and colleagues
(2011) studied the effect of differences in
tendon properties on the functionality of
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the passive stay apparatus in horses,
thereby taking major tendinous structures
into account. However, nobody seems to
have coupled the passive stay apparatus to
the rest of bodily function, balance and
posture.
Thomas Myers was the first to
dissect the lines in human cadavers and
presented his results in the book entitled
“Anatomy Trains” – also available in DVD
format (Myers, 2009). He describes 10
lines, 4 superficial and one profound from
head to toe (or if you wish, the other way
around since there is no definition of
beginning or end), 4 lines on the arms, and
one line from the arm to the lower
extremities (see table 1).
In this study we have chosen to use
the definition of the fascia as proposed and
discussed at the Fascial Research Congress
2012 (Schleip et al., 2012b), that is to say
“...fibrous collagenous tissues which are
part of a body wide tensional force
transmission system…”. With a few
exceptions this includes almost all types of
connective tissue, since they are all
regarded as being integrated in the
locomotory system.
The aim of this study was,
therefore, to reveal the inter-connective
functionality of the locomotory system of
the horse. Two hypotheses were tested,
namely; 1) that it is possible to isolate and
define fascial tissue of the equine
locomotory system, comprising a biomechanics, were made. On the basis of
continuous 3‐D viscoelastic matrix
providing structural support, and 2) that
the existence of diverse lines related to
lateral bending, extension, flexion and
rotation are not only comparable with the
human lines, but also lend support to
existing biomechanical theories such as
“bow‐string” and the “passive stay
apparatus”.
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2015 Issue 3
2. MATERIALS AND METHODS
2.1 Animals
Twenty‐six horses of different
breeds, e.g. riding horses, ponies and
Icelandic horses, were dissected. There
were both mares and geldings covering an
age range of 5 to 35 years. All the horses
were euthanized for humane reasons
unrelated to this study.
2.2 Photography
A Ricoh GX200 camera was used
for imaging the dissections and the isolated
lines, whilst a Canon EOS 6000D camera
was used for imaging the painted, live
horses. The images were adjusted using
Photoshop Cs4 software. The paint used
was theatre face paint, Grimas, (2001 De
Haarlem, the Netherlands)
2.3 Equine Lines
By intensive study of the equine
anatomy in the literature (Nickel et al.,
1977; Budras, 2009; König et Liebich,
2009; Constantinescu & Schaller, 2012)
theoretical comparison between the
anatomical description of the human lines
(Myers 2009) and possible equine lines
were made. Considerations, with regard to
differences between quadrupeds and
bipeds in terms of their anatomy and
which, theoretical suggestions to the
equine line were derived.
In the practical part of the study the
horses were euthanized and immediately
skinned. The structures of the single lines
were then identified and dissected with
direct and stump dissection techniques.
The fascial connections between the
muscles and on the bony attachments were
closely scrutinized. Bony attachments were
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dissected and isolated mostly by means of
blunt dissection, lifting the structures of
the bone.
Specific rules, as presented by
Myers (2009), were followed when
dissecting. These rules comprise, i) the
collagen fibers in any given line should be
aligned in the same functional direction, ii)
the structures of the lines should be
situated at the same level of the body, iii)
the overall function of the structures in any
given line should be similar, and iiii) the
muscles in a line should have a span over
more than one joint.
For illustration purposes the lines
were painted on a living horse (see Fig 2
and 3).
3. RESULTS
This study provided an opportunity
to look at the gross and functional anatomy
in a new broader and more kinetic
perspective. We did not make any “new”
anatomical discoveries but with the main
focus on the fascia and myofascia
interconnections we were able to arrive at a
clearer understanding and impression of
the overall interactions that exist
throughout the body as a whole. With the
help of the dissections it became clear that
the bony attachments from muscles,
tendons and ligaments were not “finally”
inserting into the periost and bone but that
part of the fibers continued into the “next”
structure/structures and formed
continuous line or continuum of tissue. We
found that it was possible to lift the
connective tissue attachments from the
bones with the aid of blunt dissection and
thereby follow the continuation of the
lines.
The course of the lines became
very clear when we looked closely at the
fiber directions of the fasciae e.g. the fascia
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2015 Issue 3
of the m. gracilis crossing over in front of
and under os pubis (see Fig.1c), and the
fibres in the fascia genus running distally
into the lig. patellare (capsula articularis)
of articulatio genus with both straight and
oblique fibres. Additionally some muscles
had their origin directly from the fascia
e.g. m. splenius from fascia
spinocostotransversarius, which clarifies
the force transmission between fascia and
muscles and supports this theory.
3.1 Superficial Dorsal Line (SDL)
The Superficial Dorsal Line (SDL)
(see fig. 1a and fig. 2a,b and c: green line)
has its origin in the hind limb phalanx
media, facies plantaris with the insertion of
the tendo m. dig. sup., the tightly
associated structures such as the fascia
digiti, fascia plantaris, lig. metatarseum
transverseum superficiale (previous: lig.
anulare proximale), m. interosseus medius
and the retinaculum flexorum. In a
proximal direction the superficial tendon
attached to the tuber calcanei on the os
calcaneus, into a tight, strong and
branching fascia that distally connected
into the origo and the body of m.
interosseus medius. Proximally the fascia
continued into the tendo calcaneus
communis. This tendon consisted of the
tendons and fascia tissue from m. flexor
dig. sup., the two heads of m.
gastrocnemius; the tendons from m. biceps
a femoris pars caudalis, and m.
semitendinosus. The epimysium of the
muscle belly of gastrocnemius was
arranged into the overlying fascia cruris,
which laterally radiated into m.biceps
femoris pars caudalis and medially into m.
semitendinosus. These two muscles
attached on the tuber ischiadicum and then
continued into the lig. sacrotuberale latum.
From here the line radiated further on into
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the ligament and into the group of spinal
muscles termed errectors; extensors;
extrinsic or epaxial muscles (m. spinalis;
m. longissimus dorsi, and m. iliocostalis)
from where epimysial radiations into the
fascia thoracolumbalis were observed. M.
longissimus capitis and m. semispinalis
capitis led the line from the thoracic region
and lower cervical vertebrae onto the crista
nuchae of the os occipitalis. From there m.
temporalis and fascia temporalis arose and
inserted onto the processus coronoideus of
the os mandibularis. The perimysium of m.
temporalis was found to fuse into the m.
masseter.
3.2 Superficial Ventral Line (SVL)
The Superficial Ventral Line (SVL)
(see fig. 2 a,b and c; blue line) has its
origin in the hind limb on the os phalanx
distalis at the insertion of the tendon from
m. extensor dig. longus and lateralis and
involved the tightly related and connected
fascial structures: fascia digitalis; fascia
dorsalis pedis and retinaculum extensorum.
Proximally the line passed over the
articulatio tarsi and branched into the
dorsally situated extensor muscles: m.
tibialis cranialis; m. extensor dig. longus
and m. peroneus tertius. The latter having
developed into a fibrous band positioned in
a groove in between the other two
extensors. The overlying fascia as well as
the peri‐ and epimysium of the three
muscles were found to be closely
interwoven into a dorsal extensor
compartment. SVL followed these fascial
relations proximally towards the stifle and
into the fascia genus. In the deeper part of
the extensor compartment SVL attached to
the tuberositas tibia and split into the
ligamentum patellae lateralis et
intermedius. In the proximal part
m.quadriceps femoris, vastus rectus was
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2015 Issue 3
included. The origo of this muscle belly
was situated on the os ischii just cranial to
the articulatio coxae and in close proximity
to the lig. ass. caput femoris, an offspring
from the tendo prepubicus. M. rectus
abdominis had its origo from the tendo
prepubicus and continued the line cranially
through m. rectus thoracis. This proximity
led into the contact of the peri- and
epimysium of m. rect. abdominis with
which the line and contact were brought
forward to the origo at os sternum and the
ventral part of pars cartilagines of arcus
costarum on the last ribs. From here the
fascia ran directly into the m. rectus
thoracis towards costa prima. We found a
short mechanical link over the os sternum
to the manubrium sterni and further on,
into the insertion of m. sternomandibularis
that brought the line up to the origo on the
ramus mandibularis and finally to the
fascia masseterica and the m. masseter.
SDL and SVL connected through
the fusion of the tendinous branch of the
temporal muscle and the deep layers of m.
masseter on the head. In the hind limb they
joined through the branches of the
suspensory ligament into the extensor
tendon and on the phalanx distalis and with
the attachment of the superficial flexor
tendon on phalanx media.
3.3 Lateral Line (LL)
The Lateral Line (LL) (see Fig. 2
a,b and c; orange line) originates in the
hind limb from os phalanx distalis, facies
dorsalis, at the insertion of the tendon from
m. extensor dig. lateralis and m. ext. dig.
longus and included the same structures as
the SVL namely the tightly related and
interconnected fascial structures: Fascia
digitalis; fascia dorsalis pedis and
retinaculum extensorum. At the level of
the articulatio tarsi the LL line split into
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the tendo m. extensor digitalis lateralis and
two thick fascia sheets, which separated
the space (lateral extensor compartment)
dorsal and plantar to the muscle.
Proximally we observed that the two fascia
sheets united in the caudolateral region and
attached to the os fibula. The LL united in
the lateral collateral femorotibial ligament,
the surrounding fascial tissue and the
fascia cruris. From here LL was found to
take two proximal pathways. The first
passed through the mid part of fascia lata
and m. tensor fascia lata to the tuber coxae
and the other comprising the caudal part of
the fascia lata and into the m. gluteus
superficialis and from here to the tuber
coxae. At this point the LL partly broke
one of the rules as it seemed to split up into
a superficial and a profound layer ‐ but
both layers were still regarded to be in the
superficial layers of the body. In addition
to this the profound layer broke yet another
rule all the way from the tuber coxae and
along the trunk. Here the fibres were
arranged in a criss-cross pattern as the line
passed through the aponeurosis and fasciae
tissue of m. obliquus externus et internus
abdominis to the arcus costalis, and further
on through the m. intercostales interni et
externi. These structures were arranged in
this angulated network. The m.
intercostalis externi et interni were found
to be covered on each side by a sheet of
fascia thoracolumbalis profundus named
fascia spinocostotransversarius as far
forward as the os costale primum, medial
to the scapula. The origin of m. splenius
cervicis et capitis were isolated from fascia
spinocostotransversarius and were found to
pass towards the origo at processus
mastoideus os temporale where their
insertion was isolated.
The superficial sheet of the LL
became integrated into m. cutaneus trunci,
which was present in the fascia
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2015 Issue 3
thoracolumbalis superficialis. In the cranial
direction this sheet integrated into the
cranially positioned m. cutaneus
omobrachialis, which was found to be
attached onto m. brachiocephalicus as well
with an origo at the proc. mastoideus at the
os temporale.
3.4 Spiral Line (SL)
The Spiral Line (SL) (see Fig. 3 a,
b and c: green, light green line) has its
origin cranially at the origo on the proc.
mastoideus os temporale of m. splenius
and follows this muscle dorso- laterally on
the neck of the horse to the fascia nuchae,
where in the region of C6‐C7-T1-T2‐T3 it
crossed under the funicular part of the
ligamentum nuchae to the contralateral
side into m. rhomboideus pars cervicalis et
thoracis. On the medial surface of the
scapula, the peri‐ and epimysium of m.
rhomboideus merged into the fascia fibres
related to m. serratus ventralis thoracis and
from there directly into m. obl. externus
abd. and continued across the linea alba
heading to the contralateral side where it
merged into the fibres of m. obl. interna
abd., which attached to the tuber coxae.
From here the SL continued with the
fascial fibers in the fascia lata and the m.
tensor fascia lata into the extensor
compartment. On the dorsum tarsi the
fibers continued into the cunean part of the
tendo m. tibialis cranialis on the medial
side. The line redirected proximally
through a mechanical link on the plantar
surface of the tarsus picking up the lateral
tendon of m. peroneus tertius and the
tendinous structures of m. ext dig lat. Here
the line continued in a proximal direction
towards and into the profound part of m.
biceps femoris towards the ligamentum
sacrotuberale latum. The fibers from here
merged over the sacrum through the lig.
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sacroiliaca dorsales where they crossed
over the dorsal midline to the contralateral
side. The rest of the line followed the SDL
along the back, thorax and neck, ending at
os occipitale close to proc. mastoideus os
temporale contralateral to the origin.
3.5 Functional Line (FL)
The Functional Line (FL) (see fig.
3 a,b and c: blue and light blue line) was
found to have its origin on the
caudomedial face at the distal end of the
humerus with the fascial attachment at the
origo of m. latissimus dorsi. The fascia
continued into the fascia thoracolumbalis
in a dorsocaudal direction and crossed the
dorsal midline, over the lumbar vertebrae,
to the contralateral side (fig. 1 b). From
here the fibers continued distally into the
fascia latae/genus and over vastus lateralis
of the m. quadriceps femoris into lig.
patellae lat. et intermedius onto the
tuberositas tibiae. Here the oblique fibers
fused with oblique fibers from the
ligamentum patellae medialis. In the
proximal direction these fibers attached to
the peri- and epimysium of m. gracilis and
m. adductor longus. Fibres crossed over at
the ventral aspect of os pubis (see fig. 1c)
and were directed cranially into the
aponeurosis of the fascia sheets of m.
rectus abdominis. The fibers followed the
muscle and fasciae in a proximal direction
along the thorax and branched into the m.
pectoralis ascendens. A fascial connection
with m. latissimus dorsi was dissected
between the olecranon and the thorax
ipsilaterally.
3.6 Front Limb Lines (FLL)
The Front Limb Lines (FLL) (see
fig. 3c). Two functionally related front
limb lines were found i) a Front Limb
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2015 Issue 3
Protraction Line (FLPL) (fig. 3c; yellow)
and ii) a Front Limb Retraction Line
(FLRL) (fig. 3c: pink). The FLL originated
cranially from the fascia cervicalis
profunda, cranioventrally from the fascia
pectoralis, caudodorsally from the fascia
thoracia profunda and thoracolumbalis,
and caudoventrally from the fascia
axillaris. The dorsal part of the scapula was
found to be the center of rotation for both
the protraction and retraction lines. Both
lines were found to have a cranial as well
as a caudal approach to the scapula. Being
aware of the movements of the scapula
during protraction and retraction makes it
easier to understand how the lines act
within the proximal part but also to project
them to the distal part in the front limbs.
The cranial part of FLPL (fig.3c;
yellow) had its origin in the fascia
cervicalis profunda, which arose in the
occipital region of the head. It was
followed via m. brachiocephalicus and m.
omotransversarius to the distal part of the
margo cranialis scapula, where it
connected with m. supraspinatus. From a
caudal direction the line approached the
scapula in the fascia trunci with a cranial
direction into m. trapezius pars thoracica
and a secondary sheet, which inserted into
m. rhomboideus thoracis. From a dorsal
direction the line adjoined m.
supraspinatus, where it fused with the
cranial part of the line. The distal part of
the line was related to those structures
which extended the front limb. At the level
of the brachium the line followed m.
biceps brachii, lacertus fibrosus to m.
extensor carpi radialis and then into the
tendo m. extensor dig. communis with a
final insertion on the processus extensorius
on the dorsal aspect of the phalanx distalis.
The FLRL (fig. 3c; pink) also had
its origin in the fascia cervicalis profunda
in the dorsal part which included the thin
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m. trapezius pars cervicalis and the much
larger m. rhomboideus cervicis. Both
muscles, and thereby also the line, attached
to the dorsal part of the margo cranialis
scapula and connected into m.
infraspinatus. From a caudal aspect, the
line arose in the fascia thoracolumbalis and
proceeded into m. latissimus dorsi and then
to m. triceps brachii, m. tensor fascia
antebrachii and fused with the cranial part
of the line within m. infraspinatus. In a
distal direction towards the brachium, the
two lines continued over the olecranon and
ventro‐medially to the m. dig. flexores into
the flexor tendons, which traversed
through the canalis carpalis and attached to
the os phalanx media and distalis due to
the insertion of the tend. m. flexor dig.
superficialis et profundus, respectively.
4. DISCUSSION
This study reveals that full-body
myofascial kinetic lines are present in the
horse. The lines were found to be very
similar to the human lines described by
Myers (2009) although clear differences
were found, which were explained by the
anatomical variations present between
bipeds and quadrupeds. Furthermore, the
addition of their known function in terms
of the structures of the lines, lends support
to their overall participation in spinal
motion.
In comparison to the human lines
described by Myers (2009) the SDL
follows the SBL well. There is a difference
at the head, where the human line ends in
the epicranial fascia and the equine line
ends in the temporal muscle and fascia. It
can be discussed as to whether m.
interosseus (suspensory ligament) in the
hind limb is involved in the equine line.
On one hand, it is a profound structure on
the plantar surface of the os metatarsale
Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved.
2015 Issue 3
and should not be part of the line. Yet on
the other hand its branches surround the
fetlock joint superficially and merge into
the extensor tendon, which can be
considered another link between the SDL
and the SVL. Another argument for its
relation is the close cohesion to the stay
apparatus, which is considered as being
one unity (Gussekloo et al., 2011).
Whether m. semimembranosus should be
included into the SDL is questionable. On
one hand the muscle is included in the
group of hip extensors (hamstrings) as also
stated in humans by Myers 2009, on the
other hand the insertion and the function in
the horse is more likely to warrant its
inclusion in the group of adductors. It
might therefore be regarded as a
connection between the SDL and the FL
through the tight fascial connection
between m. semitendinosus and m.
semimembranosus. Furthermore, the
interactive dissections revealed that the
kinetic element in this line was present and
supported by the observations of m.
gastrocnemii caput laterale et mediale; m.
biceps femoris caput caudalis, and m.
semitendinosus forming a functional sling
which is active only when the stifle is
extended.
The SVL in horses seems to fit
better than the SFL in humans in some
areas. For one thing, it shows a closer
connection at the acetabulum caused by the
lig. accessorium caput femoris, which is
absent in humans. For another, there is a
point of the cranial/proximal part of the
thorax where the horse has a m.rectus
thoracis and humans only have a thin layer
of fascia. On the neck the lines differ due
to the difference between
m.brachiocephalicus in equines and
m.cleidomastoideus in humans. Horses
have no muscle directly from the sternum
to the proc. mastoideus os temporale but
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Medical Research Archives
instead from the sternum to the mandible
and from the lateral surface of the shoulder
to the processus mastoideus. Only m.
sternomandibularis is part of the SVL in
the horse. The courses of the SDL and the
SVL follow the “Bow and String”‐ theory
in part, an explanation proposed initially
by Sleijper in 1946, and subsequently by
several other authors (Denoix, 2009;
König, 2009; Weeren, 2010). The
difference being, that the SDL and the
SVL connect the whole body from the
phalanx of the hindlimb to the mandibula.
Important actors of the passive stay
apparatus as m. peroneus tertius and m.
flex. dig. superf. were found to be part of
SVL and SDL, respectively, as well as
parts of the fine‐tuned balancing system of
the hind limb. This knowledge adds to our
understanding of why proper balance in the
teeth and articulatio temporomandibularis
(TMJ) (Evrard, 2002; Vogt, 2011) as well
as proper trimming and shoeing are
important for the performance of the horse
(Adams, 1987; Ross and Dyson, 2003).
From a theoretical point of view the
lines act on the biomechanics of the spine.
Looking at what is already known and
accepted in terms of the function of the
muscles of the SDL, the line provides
extension of the spine and the coxal joint
and flexion of the lower limb. In contrast,
the SVL acts as an antagonist through
flexion of the spine and the coxal joint, and
extension of the lower limb. When the two
lines balance each other, the spine will be
in a neutral position. Similar muscles and
fascia influence the posture of humans
(Masi et al., 2010; Myers, 2009), and it is
likely that these lines can be used to
evaluate the static and dynamic posture of
the spine in the horizontal plane
(flexion/extension) in horses. From a
dynamic point of view Rhodin (2009)
concludes that extreme neck elevation
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2015 Issue 3
(neck extension) increases hindlimb
flexion and lumbar back extension in high-
level dressage horse ridden on a treadmill.
Lesimple (2012) found that neck posture
and muscular activities are closely
correlated, thus horses with concave necks
(cervical extension) were found to have a
high level of muscle activity in the back.
These findings lend support to this line
theory.
This study found that the LL in the
horse has two courses at the pelvis, and at
the neck, depending on the horizontal
position of the spine in flexion or
extension, which can be compared to the
human lines. During extension of the spine
(SDL activation) m. gluteus superficialis
and m. splenius are more active and during
flexion of the spine (SVL activation) m.
tensor fascia lata and m. brachiocephalicus
are more active. This leads one to assume
that in a neutral spinal position these
muscles balance each other. In contrast to
the LL in humans, the equine LL has two
layers, one on either side of the scapula
caused by the sagittal orientation of the
scapula in the horse and the previously
mentioned difference of m.
brachiocephalicus compared to m.
cleidomastoideus in humans. In terms of
their function, the muscles of the LL
provide lateral flexion of the body by
unilateral contraction and the two LL´s
function in an antagonistic manner to one
another, balancing the body when straight.
It is proposed that together the
SDL, the SVL and the LL outline and
balance the body in the horizontal and
vertical planes, and that the two helical
lines appear to control the spinal rotation
of the body.
This study found that the SL has
three crossing points relative to the midline
on the trunk and the neck ‐ two dorsally
over C6 and C7 and at the tuber sacrale,
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Medical Research Archives
and one on the ventral aspect at the mid
abdominal region. Furthermore, the SL
follows the human line very closely.
Functionally, it is known that the
action of the muscles of the SL give rise
through contraction of the neck part to
lateral neck flexion with the two sides
balancing each other. Contraction of the
ventral part at the region of the abdomen,
provides flexion and rotation of the spine
which is supported by the findings of
Stubbs and colleagues (2006). In contrast,
contraction of the dorsal part provides
spinal extension and rotation in the
opposite direction. In this way the ventral
and dorsal parts of the SL act as
antagonists.
This study also found that the FL is
very similar to the human line, comprising
two passings at the midline, one dorsally
through the fascia thoracolumbalis, and
one ventrally over the os pubis through the
crossing fibres of m. gracilis (see fig. 1c).
Vlemming and colleagues (1995) suggest
that the gluteus maximus muscle and
contralateral latissimus dorsi muscle are
functionally coupled, especially during
rotation of the trunk in humans. Moreover,
Carvalhais and colleagues (2013) provided
evidence of force transmission between
these two muscles through the
thoracolumbar fascia in vivo which
supports the course of the FL. Due to the
known function of the muscles involved in
the FL, its dorsal part will provide front
limb retraction and contralateral hindlimb
retraction, as well as spinal extension and
rotation. Its ventral part counteracts with a
spinal flexion and opposite rotation
thereby acting as an antagonist.
The three major movements of
each vertebra are around: 1) the horizontal
axis: flexion and extension, around 2) the
vertical axis: lateral flexion, and around 3)
the sagittal/longitudinal axis: axial rotation
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2015 Issue 3
(Townsend, 1983; Evrad, 2002; Weeren et
al., 2010). In the light of the
aforementioned functional anatomy, it can
be argued that the five lines described in
this study are more than capable of
providing these three movements of the
spine. It should be noted, however, that
vertebral lateral flexion and rotation are
always coupled movements (Denoix, 1999;
Haussler, 2001; Faber, 2001; Denoix,
2009), which might suggest that the LL
and the helical lines also work
simultaneously. Their close connection to
movement around the horizontal plan has
already been described earlier in this
manuscript.
Finally, it should be mentioned that
the FLL differs from the “Arm Lines”
found in humans, as we have only been
able to describe two and not four lines.
They comprise a protraction line and a
retraction line. The difference might be
due to the greatly reduced rotation and
adduction/abduction properties of the
equine front limb compared to the human
arm. Further studies might, however,
reveal more front limb lines.
Just as with muscles, the lines
collaborate closely within a fine-tuned and
balanced mechanical and functional
network. Interconnections, such as those
presented in Table 2, between the
individual lines, are supported by the fact
that they share common structures. The
SDL, the SVL and the LL are
interconnected at the skull as well as in the
phalanx of the hind limb. Additionally the
SVL and the LL share the parts of the m.
brachiocephalicus over which they balance
and direct their forces. The superficial and
the helical lines also share structures
internally, and act together with the front
limb lines. These findings support a full
body model of balance and function that
includes not only the trunk, but also
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Medical Research Archives
includes the connections with the limbs
too.
5. CONCLUSION
This study, which is the first to
describe myofascial kinetic lines in a
mammal other than humans, uses
well‐described and documented anatomical
structures, and integrates new knowledge
about the importance of fascia and its
interconnectivity. In comparison with the
human lines described by Myers (2009),
this study identified 7 myofascial kinetic
lines with some variations specific to
horses, owing to inherent anatomical
differences between bipeds and
quadrupeds. For example, Myers (2009)
describes a “Deep Front Line” in humans,
which has been more appropriately
renamed the “Profound Ventral Line” in
the horse, and it is currently the subject of
a more detailed investigation to be
published at a later date.
This new knowledge concerning
the importance of fascia and connective
tissue, which forms a continuous web and
serves to connect the whole body, should
be seen as presenting the traditional static
view of anatomy at an altogether higher
level. The myofascial kinetic lines
presented in this study provide an
anatomical foundation for an improved
understanding of locomotion, one in which
the whole body is considered in a holistic
way, rather than the simplified description
of the action of single muscles and, for
example, vertebrae. Thus, as a result of the
interconnections between fascia and their
dynamic and static contractility, it is
conceivable to imagine how a publication costs, however, they had no
biomechanical problem in one region,
could easily spread to another part of the
body, for example lameness in one leg
occurring as the result of scar tissue in the
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2015 Issue 3
fascia and muscle tissue of a diagonally
opposed leg.
6. PERSPECTIVES
This study reveals a new concept
with regard to the current understanding of
equine kinaesthetic, biomechanics and
functional anatomy. It is suggested that the
equine lines described in this study can
help describe both static and dynamic
posture in terms of spinal
flexion/extension, lateral flexion and
rotation, all of which can be influenced by
fascia contraction. Furthermore, it is
proposed that the lines described in this
study form the basis of a readily useable
tool that can be applied by practitioners to
track the main cause of a locomotory
problem and understand the compensatory
patterns in a horse with impaired
performance. Finally, these findings
highlight the need for continued research
into equine fascia from a cellular in vitro
level to in vivo studies of function and
biomechanics.
7. SUPPORTING INFORMATION
“The ARRIVE Guidelines
Checklist” is followed in the manuscript
8. ACKNOWLEDGEMENTS
The study was supported in part of
the Danish foundation of Promotion of
Veterinary Science and the IVCA (The
International Veterinary and Chiropractic
Association). These funds supported the
expenses in relation to the research and
influence on the research nor on the
content of the submitted manuscript.
The authors would like to thank
Lennart Engberg Carlsen and Vibe
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Medical Research Archives 2015 Issue 3

Bøgelund Hansen for their technical

assistance, Mette Bloch Christiansen for
photography/illustrations and permission
to paint her horse, Hanne M. Holm for
technical assistance with the figures,
Adrian P. Harrison for proofreading and
not least the owners of the horses for their
generous donation.

9. AUTHOR CONTRIBUTION

VSE and RMS designed the

project, contributed data, analyzed the
data, made the figures and wrote the
manuscript.

10. CONFLICTS OF INTEREST

The authors are not aware of any

conflicts of interest associated with this
study. VSE is employed full‐time in the
Faculty of Health & Medical Sciences and
RS is self-employed – neither authors
received any payment for their work, nor
was this study sponsored commercially.

Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 14

Medical Research Archives
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Table 1
Myofascial line nomenclature in humans and horses. The left column lists the nomenclature
of the lines in humans as presented by Myers (2009). The right column presents the
nomenclature changed in this study in order to accommodate to the quadruped positions of
equines. * to be presented at a later date pending further detailed investigation.
Human Myofascial Lines Equine Myofascial Lines

Superficial Back Line (SBL) Superficial Dorsal Line (SDL)

Superficial Front Line (SFL) Superficial Ventral Line (SVL)

Lateral Line (LL) Lateral Line (LL)

Spiral Line (SL) Spiral Line (SL)

Functional Line (FL) Functional Line (FL)

*Deep Front Line (DFL) *Profound Ventral Line (DVL)

Superficial Back Arm Line (SBAL) Front Limb Protraction Line (FLPL)

Superficial Front Arm Line (SFAL) Front Limb Retraction Line (FLRL)

Deep Back Arm Line (DBAL)

Deep Front Arm Line (DFAL)

Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 18

Medical Research Archives 2015 Issue 3

Table 2
Myofascial lines share structures. These lines are presented in the left column and the shared
structured are listed in the right column.
Lines Shared structures

SDL and SL Mm. errector spinae

SVL, FL M. rectus abdominis

FL, FLRL M. latissimus dorsi and fascia thoracolumbalis

SVL, LL Connection between m. brachiocephalicus

and m. sternomandibularis
SP, FLPL M. rhomboideus cervicis

LL, FLPL M. brachiocephalicus

LL, SL Tuber coxa,

Proc. masteoideus
LL, SL Proc. masteoideus

Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 19

Medical Research Archives 2015 Issue 3

Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved. 20

Medical Research Archives
FIGURE LEGENDS
Fig. 1a shows the dissected and
isolated superficial dorsal line (SDL).
Cranial is in upwards direction. 1: fascia
and m. temporalis; 2 and 3: mm.
errectores spinae (2: mm. spinales et
semispinales; 3: fascia et mm. ilicostales et
longissimus thoracis et lumbales); 4: lig.
sacrotuberale latum; 5-6: hamstrings (5:
m. semitendinosus; 6: m. biceps femoris
pars caudalis); 7: fascia and m.
gastrocnemius; 8: tendo calcanei, tendo m.
flex. dig. superficialis et m. interosseous
medius.
Fig. 1b and 1c are close-ups of
dissected and isolated crossing-overs of the
functional line (FL), which is a helical
line. The horse was hanging in the legs
with the head downwards. Figure 1b shows
the dorsal fascia cross-over in the lumbo-
sacral fascia aligned with the m. gluteus
Copyright © 2015, Knowledge Enterprises Incorporated. All rights reserved.
2015 Issue 3
medius dexter et sinister (9). Notice the
very clear interwoven collagen fibres
crossing the midplane of the body. Fig. 1c
illustrates the ventral crossing‐over
(arrows) of the functional line (FL). The
crossing over is seen in the epimysium of
m. gracilis (10) ventral and cranial to os
pubis. The crossing-over is continuous in
the full length of the muscle with the only
interruption from the entrance to canalis
femoralis (between the black and white
arrows)
Fig.2 presents the superficial dorsal
line (green), the superficial ventral line
(blue) and the lateral line (orange) painted
on a horse. The dotted part of the
superficial ventral line (blue) and the
profound part of the lateral line (orange)
illustrate parts of the lines passing
underneath the scapula. Fig. 2a is a lateral
aspect of the three lines illustrating the
arrangement of the lines on the trunk and
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Medical Research Archives 2015 Issue 3

the extension of the lines in the head and in dorso-lateral side of the neck, and crosses
the hind limb. In fig. 2b the split of the over in the regio interscapularis to the
superficial dorsal line in a lateral section contra-lateral side. From here it continues
including the fascial connection between in a caudo-ventral direction, crosses over
m. biceps femoris pars caudalis and m. in the regio umbilicalis to the side of origin
gastrocnemius caput lateralis and a medial and proceeds to the hock in the lateral
section including the fascial connection muscle and facia compartments of the hind
between the m. semitendinosus and the m. limb. Distal and plantar to the hock it
gastrocnemius caput medialis. Fig. 2c is a redirects in a proximal direction and
close up of the interconnection between the follows the caudo-lateral compartment of
three lines in the head with the os the hind limb into the lig. sacrotuberale
mandibularis and articulatio temporo- latum. From here it runs into the dorsal
mandibularis as the region of the sacral ligaments and crosses over the
interconnection. midplane to the contra-lateral side of its
origin. In the rest of the cranial approach it
Fig. 3 shows the course of the follows the SDL. In fig. 3c the front limb
helical lines painted on a horse: The lines (FLPL and FLRL) are painted. Each
Functional Line (FL), blue and light blue of the arm lines has a cranial and caudal
colours, the Spiral Line (SL) green and inlet, which is integrated in parts of the
pale green and in addition the Front Limb different lines and as illustrated in the
Lines: Front limb Protraction Line (FLPL) figure in both of the helical lines.
yellow and Front LImb Retraction Line
(FLRL) pink. Fig. 3a. illustrates the two
helical lines on the full body of the horse.
The dotted parts of the lines illustrate the
part situated underneath the scapula. In fig.
3b the two helical lines and the dorsal
crossing‐overs from a caudo‐dorsal
perspective is illustrated and in fig. 3c the
front limb lines are painted on top of the
helical lines. An interpretation of the full
span of the two helical lines is available by
combining fig. 3a and 3b. The FL starts in
the regio axillaris, splits up in a dorsal and
a ventral part and reunite on the contra-
lateral hind limb distal to the tuberositas
tibia. Both parts cross-over the midplane.
The SL has 3 crossing‐overs. Two dorsal
(fig. 3a and b) at the regio sacralis and
scapularis respectively, and one ventral in
the mid abdominal region (fig. 3a). The
helical part of the line starts in the upper
part of regio colli lateralis at the origo of
m. splenius. It continues from here on the

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